ABSTRACT
HYPOTHESIS: Natural orifice transluminal endoscopic surgery (NOTES) has gained widespread interest as a potentially less invasive alternative to laparoscopic surgery or, else, an evolution as the next-generation surgery. The main objective of this study was to assess the safety of transluminal abdominal wall hernia repair for potential human application by specifically investigating the feasibility and challenges of using a transvaginal approach. DESIGN: NOTES ventral hernia repair via a transvaginal approach. SETTING: University Hospital (National University Health System, Singapore). PARTICIPANTS: The study utilized five female pigs (30-40 kg) between 5 and 7 months of age, which underwent abdominal wall hernia repair using a transvaginal approach. INTERVENTION: The procedures were performed using a double-channel endoscope under general endotracheal anesthesia. A mesh was placed and fixed to the abdominal wall using standard laparoscopic and endoscopic equipment. The animals survived for 2 weeks and were then euthanized and a necropsy performed. MAIN OUTCOME MEASURES: To assess the safety and feasibility of NOTES ventral hernia repair in a survival experimental model. RESULTS: All of the procedures could be safely performed using the standard equipment. At the necropsy, all meshes were well in place and mild adhesions were recorded in one animal with a small abscess in the subcutaneous area. CONCLUSION: This novel approach seems technically challenging but feasible using equipment and accessories currently available for conventional laparoscopic and interventional endoscopy with low intra-abdominal contamination and sepsis. New procedure-specific instruments and equipment need to be developed to allow the surgeon safer access and more degrees of instrument freedom.
Subject(s)
Endoscopy/methods , Hernia, Abdominal/mortality , Hernia, Abdominal/surgery , Surgical Mesh , Vagina , Animals , Disease Models, Animal , Endoscopy/trends , Feasibility Studies , Female , Follow-Up Studies , Forecasting , Minimally Invasive Surgical Procedures/methods , Minimally Invasive Surgical Procedures/trends , Postoperative Complications/mortality , Risk Factors , Survival Rate , SwineABSTRACT
Retained surgical sponge or glossypiboma is a relatively common occurrence; however, surgeons may not report these events for fear of litigation and adverse publicity. We report postoperative complications in three cases due to retained surgical sponges. The first case, a 26-year-old woman, presented with gastric outlet obstruction due to the sponge obstructing the pyloric canal three weeks following cholecystectomy, which was completely relieved following endoscopical removal of the sponge. The second case, a 32-year-old woman, presented with repeated attacks of intestinal obstruction following cholecystectomy and tubal ligation and was treated with surgical removal of the sponge. The third patient, a 40-year-old woman, presented with features of colonic obstruction following hysterectomy. Colonoscopy revealed a partial migration of the sponge through the colonic wall and on laparotomy, she was found to have multiple internal fistulae between the small and large intestines, all occurring around the inflammation caused by the retained sponge.
